diabetes, moto, insulin pumps in 2023

Fellow T1D here. 

I don't use a pump. It seems way too susceptible to damage, interference, falling off, etc. On a sweaty, humid day in the summer I have a hard enough time keeping the CGM sensors attached. Currently running a Libre 2. 

I'm not diabetic, but my daughter has had type 1 for many years, so I've seen a couple different pumps, and might have some useful info.

I know that the pumps can be easily disconnected for a bit to swim, shower, etc...  You just pause the pump, then disconnect it at a quick disconnect at the infusion set.

There's even a small cap that can keep dirt, water, etc... out of the line.

I know that when you exercise, blood sugar tends to go down, so I don't expect you'll need to wear it between motos unless you're eating.  You'll have to test that.

The Tandem tslim gets good reviews, and it has the start of autonomy, where it'll make adjustments automatically to prevent both highs and lows.

As a software engineer, I know the algorithm can be much better, but it's a start.  Honestly, I'm disappointed by the AI, but the tslim had the best reviews when we were looking, so that's what she went with.

The infusion set is pretty small and thin, so it'll probably be alright unless it gets hit by something.

Also, with the tslim, you don't need to carry the dexcom device, as the g6 (soon to include the g7) connect directly to the pump.  You don't need the dexcom device at all, for anything.

The dexcom sensors connect to one of:

The dexcom device OR the tslim

PLUS your phone.

So, if you want to read your number while riding, you'll need to carry either your pump or your phone somewhere.

If you just need to check between motos or practice sessions, then you wouldn't need to carry anything with you while on the bike.

I can answer questions specifically about the tslim.

I do know that there's a new version of the tslim being released soon that is much smaller than the current version.

I don't know If the tslim is still the best. The research we did was around 9 or 10 months ago.

I hope this helps, and I'm glad you're not letting type 1 stand in your way of doing what you want.

I've been type 1 for about 11-12 years now, and have used a pump for about 9 years. I'm using a TSlim with a G6 CGM. The first few years with it, I used to take it off to ride, but I haven't in a long time. I may suspend insulin delivery, or put it in exercise mode, but having it on has never been a problem. I actually appreciate having the CGM with me. My experience has been that it works a lot better now during activity than the old G4 versions. If the pump does get damaged, and it's under warranty, Tandem will overnight you a new one.

I've been thinking about the Omnipod, mostly since it's covered under the pharmacy side of my insurance, but the nurse at my endocrinologists office, who is also type 1 and extremely active, has told me the algorithm for the Dexcom integration doesn't work nearly as well and the TSlim, based on her experience and feedback from there other patients who are active. That being said...If you're good at self-managing, it's probably not a big deal.

I've never had an issue with the Dexcom sensors coming off, even when diving. The insets of course come off all the time, hot humid day in the summer...I almost always have to put in a new one after a day riding.

I ride some moto, off road and MTB. All with the pump on.

The AI is off by default. It's called Control-IQ.  With it off, a basal rate replaces the long acting insulin, then you just bolus with the pump, instead of having to do an injection each time.

It's probably improved since I last looked at it, but the OmniPod sticks out quite a bit since the insulin is stored at the infusion site.  It's wireless, so there isn't any tubing to deal with, but it sticks out quite a ways.  Take a look at it.  I suspect it'll be far easier to knock off then a CGM sensor.

I've taken a couple of diggers with it on, and it's never been a problem. I sometimes put the pump in one of those runners belts,  those kind with the small zippered compartments. It helps to keep it right in front of my waist too, where I think it is less vulnerable. I almost always use that if it's really muddy or dusty. All in all, I really wouldn't worry to much about wearing it, tubing aside, those little units are pretty durable.

I pretty much only use my stomach area for insets and the CGM, which probably makes it easier, just to tuck in any extra tubing in my waist. I always thought the tubing would snag or just drive me crazy on the back of my arms. I suppose i should try that one of these days.

I may try the omnipod this summer. I'll circle back around with you if I do. I'm kinda curious what you think of the G7...do you notice any difference between that and the G6?

I've had Type 1 since 2013. I currently use the tSlim x2 with Dexcom G6. I have waist band that holds my insulin pump so I can still ride with it connected. For track days I won't wear it if I'm only doing a few laps, but when I'm riding trails or anything enduro style I wear the pump. I usually get my blood sugar up to around 180-190 then set the pump to exercise mode. I'm usually good for 3-4 hours but always have snacks with me.

Hope that helps, and if you have any other questions feel free to ask.

Also, I broke my back last August riding and had my pump on. Thankfully I did otherwise it would have been a long time before I had any insulin in my system. (Took 5 1/2 hours to reach a hospital from where I was.) Broken T-3 to T-6 and moderate brain bleed.

Wow, sounds like a bad one. Hope all is well with you now. One more good reason to have the pump along.

Current Tslim and Dexcom CGM with Control IQ user here too, pump for over 10 years (T1 for 28 years).

The pump will change your life. Honestly, moto shouldn't even factor into it because the other 99% of your life will be that much easier.

With that being said, look into Skin Tac wipes (can get them on amazon) for better adhesion of sensors and infusion sets. I can swim in the ocean/pool and not lose infusion sets during the 3 day period. Also, 3M Tegaderm films can be placed over the CGM sensors (thin, sticky, clear adhesive film) and act as another layer of adhesion and a barrier from the elements. I also use them for pump infusion sets (just cut a hole around where the tubing attaches).

There are solutions out there and you definitely shouldn't let the fear of losing sensors and infusion sets from deterring you. Hope this helps.

Also, I race 2 hour hare scrambles and take the pump off. If you prepare (bolus) accordingly, you should be able to come up with a workable plan for moto.

Didn't really think it was as bad as it was when it happened! Thank you, doing well now! Back on a mountain bike and feeling good. Back to moto this fall I'm thinking.

I’m a newer type 1 just this year and I know everyone is different for how they burn off the sugar but I know a couple other local people to me run a pump and take it off before the first moto and as long as they stay consistent throughout the day with carbs it works out. I guess I’m lucky I get away with a Lantus dose at night and just have to eat right and use a Libre 3 and usually don’t have a problem. Doing everything I can to avoid a pump but my nutritionist said she’s had luck with people taking the pump off before any athletic stuff and eat enough to stay a little high to be on the safer side 

No worries. Its intimidating, but honestly, once you start to live with it and see the positives, it will become second nature. As someone who was always "yeah pumps not for me", once my doctor convinced me i regret not doing it sooner. 

And also, speaking from personal experience and by all means not suggesting you do this, infusion sets will last longer than the three days they indicate. They're worried about insulin crystalizing in the infusion set (which it can....but it takes a while). But in reality, it will fall off due to adhesive failure long before that is a concern.

For the first year after diagnosis, I’d probably discourage someone from using a pump. Usually the pancreas will still be kicking out insulin randomly every now and then and the chances of a severe low blood sugar from ‘doubling up’ is higher.  That first year I’d just look to try to stay below 200 as much as possible, maybe closer to 150 as you get closer to the end of the first year. 

That's a very good point. The "honey-moon" phase is a real thing. I did MDI's for about 8-10 months before I used a pump because of this. Your pancreas will continue to secrete some insulin for a little while

I ignored all the symptoms for over 6 months and my A1C was 14, but wouldn’t a pump be the very thing that would help in that situation because it would adjust compared to Lantus that just hits no matter what? All 4 doctors I’ve talked to have all strongly pushed me towards a pump 

My wife is type 1 and uses the Dexcom G6 with her IPhone and an Omnipod. My two cents is the Dexcom is great and the Omnipod is always a problem. If she even bumps into something it’ll get knocked off of her. And sometimes they just stop working. If we had a dollar for every one that’s gone bad I could get a new bike. She’s seeing a new endo so maybe he’ll change it. 

My endo said she starts all new Type 1's with pens, one of the main reasons is so her patients learn how to manage it, and suggests a pump for them later. I think it's a good idea, and I would also agree not to get too caught up chasing a low and narrow range the first year, while your pancreas is still producing insulin in spurts. I still use a pen instead of the pump from time to time, depending on what I'm doing, and so I still remember how. I also know a few long time type 1's who still use pens and have very good control.

That being said, I absolutely advocate for using a pump instead of pens. Like MX915 mentioned above, for most of everything you do, I think it offers you much better control and flexibility in almost every situation. You can fine tune your BG numbers I find much easier. In addition to having an easy bolus available if you suddenly decide to grab a meal while you are out, you can also back off your basal rate easier, depending on what you are doing, instead of relying on eating to keep your BG up. And if you are really worried about it during activities, just take it off. That works too. I primarily just leave mine on for the CGM integration.

I'm using the TSlim\Dexcom combo FWIW.

I started using the Daxcon 6 about 2 months ago and it was reliable. My wife had been using the 6 for several months. We found out they had a new 7 and we have both been using it for about a month and unfortunately it has not been as reliable and even gave me few false low 40’s readings in the middle of the night then it died with 3 days to go. We will probably be going back to the 6 when we run out of the 7’s.

There have been a lot of advances in pumps since my wife and daughter got their first ones, so perhaps they work better now than before.  Both of them have gotten new ones in the last 2 weeks and I am not as familiar with them as the first ones (that they stopped using several years ago for various reasons).  

The initial ones didn't have CGMs connected, so everything was manually input as far as blood sugars, carb intake, etc.  You entered in the grams of carbs ingested and it metered it out over a certain amount of time.  Basal rates were somewhat adjustable also.  

The issue with the first year is that with the pancreas 'sputtering' out insulin randomly, the newer pump would have a very difficult time developing an accurate algorithm of how your body was really processing the carbs and insulin.  The pancreas could kick out insulin suddenly at 2AM while you are asleep and there might not be a way to raise the blood sugar levels if you were by yourself or no one woke up from an alarm.  

If the doctors are telling you that you need a pump, then I would definitely follow their advise over mine!  The tech could be so much greater now that the things that would worry me are not an issue anymore.  

Good luck, and the only advise that I will always give set in stone is that if you get a chance to talk to the doctors and nurses at a Children's Hospital about T1, you will get exponentially better information than any doctor that normally sees adults diagnosed with T2.  My wife was (mis)diagnosed at the age of 30, and received hardly any good info.  My daughter was diagnosed at 14 and spent the first week at Children's Hospital in Seattle and we left there understanding the disease about a thousand times better than before.  

I have had type 1 for over 31 years now. I can second what a lot of these guys are saying. I have always taken my pump off before riding. You can plan ahead and give yourself some insulin before disconnecting to keep you in range during the time off the pump. Or if you are like me, the physical activity lowers my blood sugar so disconnecting the pump and having it protected in my camelback is perfect for me and I dont have to worry about snagging it on anything while riding.

I currently use a medtronic 770G pump and cgm and i can say that from speaking to others that use the dexcom gcm, the dexcom gives slightly more accurate blood sugar readings compared to mine. But a cgm will not give you perfect readings, it is more of a tool to give you data on how your blood sugar is trending. I've heard great things about the Tslim but I personally did not like the rechargable battery feature on it, but it mostly comes down to which cgm brand you would want to use between the two brands. I think having something you can easily remove is key for riding as it can flop around, get hit, bushwacked, you can fall on it, etc. If i end up going high during a ride I can just connect my pump and correct, and then take it off again and go. 

I havent really had any issues with my pump site staying on with sweat and activity, however, the cgm is a different story. You can use tack wipes, overtape, and other similar products to keep them on better but if I sweat a lot during summer months they tend to peel off a day or two early. 

Pumps are pretty durable my wife is type 1 since she was a kid.  She doesn't ride but used to do a lot of Judo and Jujitsu.  She is always banging it on a counter top and stuff also.  I can see how you wouldn't want it on while riding though.  She does like some of the others have suggested and pops is off if she needs to.  I would think that would be a good option depending how long you are riding for.  Sweating does cause issues but she has found these new deals called Stay Put it's basically kinesio tape.  It works way better for holding her sensor ands staying put at the gym and stuff and it breathes better and doesn't trap sweat behind it.